From the Guidelines
The highest blood pressure at which a woman may safely receive combined oral contraceptives is generally considered to be below 160/100 mmHg, but ideally below 140/90 mmHg, as women with blood pressure at or above this threshold have a relative contraindication to estrogen-containing contraceptives due to increased risk of cardiovascular complications, as evidenced by the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 1.
Key Considerations
- Women with systolic blood pressure between 140-159 mmHg or diastolic blood pressure between 90-99 mmHg are classified as category 3, indicating that the risks of using combined oral contraceptives generally outweigh the benefits, but may be used in some cases with careful monitoring 1.
- Women with systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg are classified as category 4, indicating that the risks of using combined oral contraceptives outweigh the benefits, and alternative contraceptive methods should be considered 1.
Alternative Contraceptive Methods
- For women with blood pressure above the recommended threshold, progestin-only contraceptive methods, such as the progestin-only pill (mini-pill), hormonal IUDs, implants, or injections, may be considered as alternative options, as these do not significantly affect blood pressure.
Monitoring and Follow-up
- Regular blood pressure monitoring is essential for any woman with hypertension who uses hormonal contraception, with measurements recommended at initiation and during follow-up visits.
- Women with controlled hypertension who are on antihypertensive medication and have no other cardiovascular risk factors may be able to use combined oral contraceptives with careful monitoring, but this should be determined on a case-by-case basis, taking into account the individual's specific health status and risk factors, as well as the potential benefits and risks of hormonal contraception, as outlined in the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 1.
From the Research
Blood Pressure and Oral Contraceptives
- The relationship between blood pressure and oral contraceptive use has been studied in various research papers 2, 3, 4.
- According to a study published in 2003, hypertensive women using oral contraceptives presented a significant increase in diastolic blood pressure and poor blood pressure control, independent of age, weight, and antihypertensive drug treatment 3.
- Another study from 1977 found that oral contraceptive use is associated with a slight but statistically significant rise in mean blood pressure, which is reversible 4.
- However, none of the provided studies specify the highest blood pressure a woman may have and still receive oral contraceptives.
- A study from 2009 discusses the safety, efficacy, and patient satisfaction with continuous daily administration of levonorgestrel/ethinylestradiol oral contraceptives, but does not provide information on blood pressure limits for oral contraceptive use 2.
Key Findings
- Oral contraceptive use is associated with an increase in blood pressure 3, 4.
- The clinical implications of a mild contraceptive-induced blood pressure elevation remain unsettled but disturbing 4.
- There is no specific information available in the provided studies on the highest blood pressure a woman may have and still receive oral contraceptives.